CLEVELAND, Ohio – The House bill to repeal and replace parts of the Affordable Care Act makes big changes to how Medicaid operates and is funded, and those changes have healthcare providers worried.

Officials at area hospitals fear the cuts will come on the backs of the most vulnerable in the state.

The American Health Care Act, AHCA, in its present form heading to the Senate, would reduce Medicaid spending by roughly $839 billion over 10 years, according to estimates by the Congressional Budget Office. The bill also would discontinue Medicaid expansion and change the funding mechanism for Medicaid. Whereas states now receive matching funds from the federal government for their Medicaid expenses, they instead would receive funding via block grants or on a per-capita basis.

“What we have now, I just think it jeopardizes the coverage of millions,” said Tracy Carter, MetroHealth System’s senior director of state and federal government relations. “Some of the provisions, I think, will put some of the sickest and older populations at risk, and that’s something we have great concerns about.”

MetroHealth, which is considered the county’s safety-net hospital, provides care for anyone – whether or not they have health insurance. The hospital system treats nearly 30,000 people through the Medicaid expansion, and 75 percent of its services are dedicated to patients with Medicaid or Medicare.

Since the state expanded Medicaid in 2014, 702,000 Ohioans have gained medical coverage.

“It would cut the total amount of money to Medicaid very substantially,” said J.B. Silvers, a professor of health finance at the Weatherhead School of Management at Case Western Reserve University.

Charlie Solley, director of government relations at Akron Children’s Hospital, said the state will lose an estimated $19 billion to $26 billion during fiscal years 2019 through 2025, if the proposed changes go into effect.

“It’s such a large fundamental change that’s been proposed,” Solley said.

He worries that under-funding Medicaid would create more competition for healthcare in the state, which could potentially put vulnerable populations like children at risk. At Akron Children’s, 50 percent of the children served are covered by Medicaid.

“This funding mechanism will drive these difficult decisions down to the state level,” Solley said. “Kids don’t call their governor. Kids don’t call their legislators. Kids don’t go to town hall meetings. They need adults to advocate for them.”

He said the hospital is “concerned” by the AHCA and thinks “kids stand to lose.”

“Kids should not be the victim of a repeal and replace effort that is misguided,” Solley said.

Reducing Medicaid spending in general hits the most vulnerable populations and any reductions will affect the ability of providers to serve patients, according to Carter, who would like to see the Senate make major changes to the AHCA.

“I think the Senate has every opportunity to design a reform package that would be in the better interest of patients moving forward,” Carter said.